Kidney pantoprazole

AIN is a relatively uncommon cause of kidney disease, accounting for only 2-3% of all renal biopsies [33-35]. However, in patients with acute kidney injury (AKl) who have normal sized kidneys on ultrasound, AIN is much more common, accounting for up to 27% of biopsies [36]. Omeprazole was fhe first PPl described to cause AIN. In this case, a 74 year old female on omeprazole therapy for 6 months developed fatigue, malaise and was noted to have hematuria, proteinuria and eosinophiluiia [17]. Over the next 12 years, 29 cases of AIN associated with omeprazole were published, 23 of which were biopsy proven [18-23]. In 2004 other PPls were implicated in two large case series that included omeprazole, lansoprazole and pantoprazole [24, 25]. 

Lorf T, Ramadori G, Ringe B, Schworer H. Pantoprazole does not affect cyclosporin A blood concentration in kidney-transplant patients. Eur J Clin Pharmacol 2000 55(10) 733-5. 

Proton pump inhibitors may affect renal, and possibly hepatic, clearance of methotrexate by inhibition of methotrexate transporter proteins. It has been suggested that omeprazole may inhibit the activity of a hydrogen-ion dependent mechanism in the kidney, on which methotrexate depends for its excretion, so that its loss is diminished. It has also been suggested that the situation with lansoprazole may be similar, but that pantoprazole may differ since at about the pH found in the renal tubules (pH 5), pantoprazole is more slowly activated than omeprazole. However, a case of an interaction with pantoprazole has also been reported. ... 

Studies in kidney transplant patients have found that pantoprazole 40 mg onee daily does not affeet eielosporin blood levels when given in the evening, or when both drugs are given together in the morning. ... 

Kidney A 73-year-old man complained of tiredness, nausea and anorexia. His medical history included congestive heart failure, and rheumatoid arthritis. His current medications included furosemide, ramipril and sulfasalazine. Two months earlier he had started pantoprazole for gastro-oesophageal reflux disease. At physical examination he... 

Both omeprazole and pantoprazole react with vacuolar H ATPase, as inferable from their abilities to inhibit acidification in purified kidney lysosomes [27]. However, they did so with low potencies, concentrations needed for half-maximal inhibition (IC50) being 75 and 195 pmol/1, respectively. Protection of the enzyme by 10 p.mol/1 glutathione suggested an extralysosomal action (at the neutral pH of the incubation medium), rather than an effect secondary to intralysosomal activation. 

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